Urinary and anal incontinence after vacuum delivery
ABSTRACT To evaluate urinary and fecal incontinence symptoms, and occult anal sphincter defects in women after vacuum and spontaneous vaginal delivery.
In a case-control study, 50 primiparous women delivered by vacuum extraction were compared to 50 women delivered spontaneously. Urinary and anal incontinence symptoms, pelvic floor muscle strength and sphincter defects on endoanal ultrasound were evaluated 6-24 weeks postpartum.
New anal incontinence symptoms after childbirth were found in 30% of the vacuum group compared to 34% of the controls, new urinary incontinence symptoms in 28 and 42%, respectively (not significant). After excluding Grade III perineal tear, sonographic sphincter defects were found in 11 (27.5%) after vacuum delivery compared to 4 (10%) after spontaneous delivery (P<0.05, chi(2)-test).
Anal and urinary incontinence symptoms are frequent after vaginal delivery. Vacuum delivery causes more sonographic sphincter defects but appears to cause no more harm to pelvic floor function than spontaneous vaginal delivery.
SourceAvailable from: Somchai Tanawattanacharoen[Show abstract] [Hide abstract]
ABSTRACT: To assess prevalence of Urinary Incontinence (UI) during the late third trimester and three months postpartum period in King Chulalongkorn Memorial Hospital. The present study population comprised > or = 36 weeks singleton pregnant women attending the ANC at King Chulalongkorn Memorial Hospital between 2009 and 2010. Questionnaire was developed from International Continence Society Questionnaire, which consisted of two parts, (1) socioeconomic demographic, characteristics related to UI, and (2) obstetric characteristic, UI experienced after delivery. Validity and reliability of the questionnaire were tested (Cronbach's alpha = 0.8). Chi-square, t-test, Pearson correlation McNemar test, and Binary logistic regression were used for comparison. The majority of the participants (93.8%) were aged between 20 and 39 years old. The prevalence of UI during late pregnancy and three months postpartum were 53.8% and 7.8%, respectively. This difference reached statistical significance (p < 0.001). There were 53.5% of stress UI, 20% of urge incontinence, and 7.8% of mixed type UI during late third trimester, whereas only stress UI was found in three months postpartum period. The only risk factor for late antenatal and early postpartum UI was high pre-pregnancy BMI (OR 2.3; 95% CI 1.38-3.85, p < 0.001 and OR 3.3; 95% CI 1.8-6.0, p < 0.001, respectively). The prevalence of UI was quite high during the late third trimester (53.8%) and decreased significantly three months postpartum (7.8%). Pre-pregnancy BMI is the only risk factor for developing UI in late antenatal and early postpartum period. This may help obstetricians for prediction and prevention of UI during pregnancy and postpartum in high-risk group.Journal of the Medical Association of Thailand = Chotmaihet thangphaet 02/2013; 96(2):144-9.
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ABSTRACT: Objective To determine the prevalence of fecal incontinence after childbirth and to identify the risk factors. Methods This was a prospective observational study with a consecutive inclusion of 525 women who delivered over a three months period. Women were questioned about their fecal continence four days and six weeks after delivery. Results The incidence of fecal incontinence four days and six weeks after childbirth was respectively 8.8% and 3.3%. The risk factors for fecal incontinence at 4 days after childbirth were instrumental delivery by forceps (adjusted odds ratio 8.64, 95% confidence interval 3.55-21.0, p<0.001) and unassisted delivery at home (adjusted OR 8.06, 95% CI 1.30-50.0, p=0.025). Independent risk factors for the presence of fecal incontinence 6 weeks later were: instrumental forceps delivery (adjusted OR 10.8, 95% CI 2.82-41.3, p=0.001), unassisted delivery at home (adjusted OR 50.0, 95% CI 3.09-802, p=0.006), bi-parietal diameter of the newborn >93mm (adjusted OR 4.56, 95% CI 1.46-14.1, p=0.009) and maternal age >30 years (adjusted OR 4.60, 95% CI 1.11-19.1, p=0.036). Conclusion Fecal incontinence is common after childbirth and its prevalence is predominantly associated with instrumental delivery, unassisted delivery at home, bi-parietal diameter of the newborn and maternal age.Fuel and Energy Abstracts 10/2004; 33(6):497–505. DOI:10.1016/S0368-2315(04)96562-3
Article: Périnée et grossesse[Show abstract] [Hide abstract]
ABSTRACT: Congenital factor, obesity, aging, pregnancy and childbirth are the main risk factors for female pelvic floor disorders (urinary incontinence, anal incontinence, pelvic organ prolapse, dyspareunia). Vaginal delivery may cause injury to the pudendal nerve, the anal sphincter, or the anal sphincter. However the link between these injuries and pelvic floor symptoms is not always determined and we still ignore what might be the ways of prevention. Of the many obstetrical methods proposed to prevent postpartum symptoms, episiotomy, delivery in vertical position, delayed pushing, perineal massage, warm pack, pelvic floor rehabilitation, results are disappointing or limited. Caesarean section is followed by less postnatal urinary incontinence than vaginal childbirth. However this difference tends to disappear with time and following childbirth. Limit the number of instrumental extractions and prefer the vacuum to forceps could reduce pelvic floor disorders after childbirth. Ultrasound examination of the anal sphincter after a second-degree perineal tear is useful to detect and repair infra-clinic anal sphincter lesions. Scientific data is insufficient to justify an elective cesarean section in order to avoid pelvic floor symptoms in a woman without previous disorders.Gynécologie Obstétrique & Fertilité 05/2010; 38(5):332–346. DOI:10.1016/j.gyobfe.2010.03.008 · 0.58 Impact Factor